NPIMap

Organization Active NPI

Tioga Health Care Providers, Inc

  • Surgery Physician
  • Wellsboro, PA
National Provider Identifier
1003255159
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
TIOGA HEALTH CARE PROVIDERS, INC
Practice address
1 Main St
Wellsboro, PA 16901-1601
Phone
(570) 723-0716
Fax
(570) 723-0638
NPI assigned
Jun 21, 2013
Organization subpart
Yes
Parent organization
SUSQUEHANA HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald M Gilbert Jr.
Title
Cfo
Phone
(570) 723-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1 Main St
Wellsboro, PA 16901-1601

Mailing address

22 Walnut St
Wellsboro, PA 16901-1526
Phone (570) 723-0600

Other names 1

  • Susquehanna Health General Surgery at Wellsboro Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131024001380 PA Part B Supplier - Clinic/Group Practice 3375597792 Receives reassigned benefits from 18 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wellsboro, PA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Susquehanna Health OB and GYN at Soldiers and Sailors Mem Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427846400000",
    "number": "1003255159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WALNUT ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011526",
            "telephone_number": "570-723-0600",
            "fax_number": "570-724-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011601",
            "telephone_number": "570-723-0716",
            "fax_number": "570-723-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA HEALTH CARE PROVIDERS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUSQUEHANA HEALTH SYSTEM",
        "enumeration_date": "2013-06-21",
        "last_updated": "2015-04-01",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-723-0600",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health General Surgery at Wellsboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.